Annual lung cancer screening rates are still low: there are many reasons why
According to a new report from the American Lung Association, fewer than 6% of high-risk smokers get tested annually for lung cancer, as recommended by health authorities, even though the test can detect lung cancer early when is still curable.
This begs the question: why are testing rates so miserably low?
“There are a lot of reasons why,” said the report’s lead author, Zach Jump, MA, of the American Lung Association in Chicago. Medscape Medical News.
First, although nearly 10 years have passed since the original recommendation by the US Preventive Services Task Force (USPSTF), it takes time to get people to take action, Jump suggested. “Even for long-running cancer screening programs like mammograms, screening rates are far lower than we would like, so our best hope is still lower than we would like.”
Importantly, in March 2021, the USPSTF expanded screening recommendations to include a wider age range and more current and former smokers than was originally recommended for screening. “This recommendation almost doubled the number of people eligible for screening, which means all of a sudden our denominator almost doubled,” Jump observed. In other words, proportionally fewer people are currently being screened because the pool of eligible people is nearly double what it was before the USPSTF made its initial recommendation.
A lot of work and “buy-in” must also take place before a screening program can be established. For example, in a recent briefing, practicing pulmonologists told the American Lung Association how difficult it can be to set up a screening program to make it a success. Not only must the administration see the value (and cost-benefits) of offering a lung cancer screening program, there must be an advocate for the program and a sufficient number of employees who must themselves provide the actual services and see the value of the program too.
In its defense, the American Lung Association has implemented multiple outreach efforts aimed at educating providers on the benefits of screening. They have also launched multi-pronged educational efforts with the public – for example, placing materials in waiting rooms so that patients and family members are better informed about the benefits of annual lung cancer screening. They also have a large online presence in the form of the “Saved by Scanning” campaign.
“This campaign has been very broad and encourages people to go to the website to see if they are eligible for testing and, if so, to find a local testing center or at least speak to their provider of their risk,” Jump explained. .
The American Lung Association has also made major inroads in getting Medicaid coverage for people who want to get screened for lung cancer – in just one year, the association convinced six states to cover screening by Medicaid – to the point where now very few states do not provide coverage.
And there is progress: despite a major setback in 2020 due to the disruption of the COVID-19 pandemic on all health services, “lung cancer screening has steadily increased globally nationally, so overall we’re seeing an increase in numbers, although even the top US has a lot of room for improvement,” Jump acknowledged.
Perhaps the most difficult aspect of getting more high-risk patients screened is the “fatalistic” attitude that most smokers have toward smoking. When screening was first recommended, the American Lung Association held a slew of focus groups, and in talking to smokers and focus groups, they heard a lot about this fatalistic attitude. “There’s a huge amount of stigma around smoking that we really want to fight,” Jump commented.
Typically, smokers blame themselves for smoking (and later blame themselves if they develop smoking-related illnesses, including lung cancer), he explained. Additionally, “tobacco is incredibly addictive and there are a lot of influences from the tobacco industry that got people started and kept going,” Jump added. The fact that a lung cancer diagnosis once meant death — and patients clearly didn’t want to hear about it — didn’t exactly entice smokers to get tested.
But with screening, a diagnosis of lung cancer is no longer a death sentence, it’s a whole new world. “We’re talking about something that we can detect early, patients can have it cut off and then live the rest of their lives, and [instead] worry about all the other diseases that we all worry about,” Jump said.
Moreover, the treatment of lung cancer, and the advent of immunotherapy and targeted therapies, has significantly improved its prognosis, even that of metastatic lung cancer. “So we’re trying to get that message across and shift the national expectation from a ‘death sentence’ to a message of hope,” Jump said.
Returning to the annual report, Jump said: “We started this report [5 years ago] when screening became a thing and our hope was to really get the message across that screening is effective and useful. But we also want to be able to show the effectiveness of screening in the future – not only that a clinical trial has shown screening to be effective, but here’s the real-world data and here’s what’s happening now. Here are real lives saved, here is increased early detection of lung cancer, and here is increased survival.
“So it’s important that we have something that’s accessible to the everyday person, but also that we can stand up for what we know can save lives.”
5th Annual Report “The State of Lung Cancer”. Published online November 15, 2022
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